TB SCARE IN BOSTON

A surgical intern has been found to have untreated TB, and everyone is in a tizzy....
Several comments.
First, if you apply to work as a nurses' aid, you need a TB skin test. If it is positive, you get an X Ray and then if you haven't been treated, you get treated...
Both my son and I am "PPD POSITIVE" i.e. test positive for the TB germ, but have a normal chest X Ray. Since we were both diagnosed under age 40, we were treated with INH: I was treated for a whole year, but now they only treat for six months. This kills any germs hiding that might "reactivate" into active TB...but there is a risk of INH hepatitis, more commonly over age 40, so if you are over age 40, they won't treat, since the risk of TB is less than the risk of hepatitis...
There are now guidelines to treat all diabetics with positive skin tests, no matter what age. And also those with immune problems...
I know in the Indian health service, where we see both a lot of TB and a lot of Diabetes this is being done. However, I suspect it is not done routinely.

TB is usually in certain populations. If you want to have TB recognized on your x ray, find a foreigner to read it, or have someone who worked with American Indians to read it...Ironically, I picked up two active cases of TB that were missed when I worked for the IHS, because I saw a lot of cases in Africa and recognized the symptoms.
In both cases, the hospital personnel freaked out...worried they might have caught it...
This is not an idle threat. About twenty years ago, a cook in the Congressional dining room staff had TB and there were 100 plus cases and one or two deaths from it.
TB has two phases: The early phase is like a viral pneumonia, but can also spread to other organs...and be missed. One case in Africa where I couldn't figure out what was wrong tested positived in his bone marrow, but not his sputum...he had "miliary TB (because the tubercules of early tb are the size of a millet sead).
The typical cases are "secondary" where you see large tubercules: About the size of a marble in the upper lobes. The body walls off the TB germ in abcesses, then if the walls of the abcess break down, you get massive spread and sometime bleeding that can be fatal.